Healthcare Provider Details

I. General information

NPI: 1225145113
Provider Name (Legal Business Name): JENNIE CHING HWANG-LU LCSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST RD
MONTROSE NY
10548-1454
US

IV. Provider business mailing address

2094 ALBANY POST RD
MONTROSE NY
10548-1454
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax: 914-788-4371
Mailing address:
  • Phone: 914-737-4400
  • Fax: 914-788-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9630
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR048585-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: